PRE-ECLAMPSIA AND ANEURISMA, A DANGEROUS MIXTURE

Objective: Pre-eclampsia continues to be an important cause of maternal and infant morbidity and mortality, maintaining its incidence despite advances in knowledge. This situation is aggravated in our environment mainly due to maternal age, comorbidities and assisted reproduction techniques. In view of this situation, eight years ago we created a specialized unit on hypertensive disorders in pregnancy. Our clinical case is a demand for more attention and research into pre-eclampsia. Design and method: The patient is a 28-year-old woman, with no pathological history and no complications during the follow up of her pregnancy. She attended the gynaecological emergency department at 36 + 4 weeks due to a sudden onset of headache, epigastralgia and severe arterial hypertension. Blood tests showed elevated transaminases and low platelets and severe proteinuria. A diagnosis of pre-eclampsia and associated HELLP syndrome was made and treatment with intravenous labetalol and magnesium sulphate was started. An emergency caesarean section and subsequent admission to the Intensive Care Unit was performed. Despite a better of blood pressure, headache persisted and the patient suffered a seizure. Study with computed tomography scan showed a bilateral superficial subarachnoid haemorrhage and an arteriography showed a small left carotid-cavernous saccular aneurysm, with a filling defect of the right transverse sinus and internal jugular vein (suspected hypoplasia). She underwent pharmacological angioplasty for a small vessel vasospasm of the right middle cerebral artery. The discovery of the aneurysm in the patient led to a family study which also confirmed this finding in the patient’s mother and younger sister. Her favourable evolution allowed the antihypertensive treatment (calcium antagonist) to be withdrawn. We followed her up for almost two years after the event, as did the neurologists, neurosurgeons and psychologists. Results: Why did severe pre-eclampsia occur in a non-risky patient? What could we have done to prevent this situation? What about the finding of a cerebral aneurysm? What advice and follow-up regarding the pregnancy does her sister need? What could we do for future pregnancies? Conclusions: A serious situation, such as preeclampsia with associated HELLP syndrome, has revealed a vascular malformation that could be familial related.